03 Heunis, Kigozi & Engelbrecht Sahara Conference 2009 Fin

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03 Heunis, Kigozi & Engelbrecht Sahara Conference 2009 Fin

  1. 1. Christo Heunis Gladys Kigozi Michelle Engelbrecht Centre for Health Systems Research & Development University of the Free State
  2. 2. Source: WHO 2009: 81-168
  3. 3. Source: WHO 2009: 81-168
  4. 4. Source: WHO 2009: 28
  5. 5. Free State 31.1%-32.9% Thabo Mofutsanyana Lejweleputswa 32.2-33.1% 34.8%-33.8% Source: DoH (2009)
  6. 6. Free State 43.1% -45.9% Thabo Mofutsanyana Lejweleputswa 37.9%-49.7% 32.4%-44.6% Source: FSDoH (2009)
  7. 7. Free State 60.3%-65.3% Thabo Mofutsanyana Lejweleputswa 63.2%-67.3% 63.8%-67.6% Source: FSDoH (2009)
  8. 8. Mechanisms for collaboration between TB and HIV programmes Intensified TB case- finding among PLWHA IPT for PLWHA without active TB Improved infection control in health-care and congregate settings HIV testing for TB patients CPT for TB patients infected with HIV
  9. 9. Identify factors impacting on uptake/non-uptake of HIV counselling and testing by TB patients from the perspectives of (1) patients, (2) professional and (3) community health workers Propose recommendations to increase uptake of HIV testing by TB patients
  10. 10. Cross-sectional face-to-face interview survey: Feb-Mar 2008 61 PHC facilities offering: o TB services o HIV counselling and testing services Sample o 600 TB patients o 81 professional health workers o 97 lay health workers Voluntary, informed consent
  11. 11. Variable n % Female 310 51.7 Unemployed 513 85.5 Retreatment 232 38.7 Did (self-reportedly) not receive information on the link between TB and 214 35.7 HIV/AIDS
  12. 12. Thabo Lejweleputswa Total (%) Mofutsanyana Fixed clinics Manager 4 1 5 (6.2%) Manager/TB/HIV nurse 6 5 11 (13.6%) Manager/TB nurse 2 4 6 (7.4%) Manager/HIV nurse 1 3 4 (4.9%) TB/HIV nurse 2 1 3 (3.7%) TB nurse 3 3 6 (7.4%) HIV nurse 4 4 8 (9.9%) Mobile clinics Nurse 5 5 10 (12.3%) Hospitals Nursing services 4 4 8 (9.9%) manager Doctor 4 4 8 (9.9%) TB nurse 3 2 5 (6.2%) HIV nurse 2 2 4 (4.9%) TB/HIV nurse 1 2 3 (3.7%) Total 41 40 81 (100%)
  13. 13. n % Lay counsellors 40 41.2 DOT supporters 57 58.8 Total 97 100
  14. 14. Qualitative: simple content analysis Quantitative: uni-, bi-, multi-variate (logistic regression) analysis
  15. 15. Odds ratio (95% CI) Odds ratio (95% CI) (adjusted Variable (unadjusted model) for all other factors) Received TB-HIV information 3.9 (2.7-5.6)** 4.1 (2.5-6.7)** Ref: Not received Know someone ill with HIV/AIDS 3.0 (2.0-4.3)** 3.5 (2.2-5.7)** Ref: Not know Unemployed 2.6 (1.6-4.1)** 2.3 (1.2-4.3)** Ref: Employed Female 1.9 (1.3-2.7)** 2.2 (1.4-3.6)** Ref: Male Retreatment 1.8 (1.3-2.6)* 2.0 (1.3-3.3)* Ref: New * Significant at 5% level ; ** Significant at 1% level
  16. 16. Shortage of nurses Insufficient training on TB/HIV integration Inadequate space for counselling Lack of patient trust in lay counsellors
  17. 17. Re-offer HIV counselling and testing at every opportunity Supply TB-HIV (“the link”) information Motivation & support Availability of antiretroviral treatment
  18. 18. TB patients’ fear of HIV, TB/HIV co-infection, death TB patients’ fear of anticipated stigmatisation/discrimination should they test HIV- positive
  19. 19. Encouragement and motivation
  20. 20. Intensifying education on the link between TB and HIV Motivating patients in the decision-making process Targeting especially males, newly diagnosed and employed patients Improving DOT supporters and counsellors’ training and skills Public Health Evaluation (PHE) protocol submission to CDC pending: quasi-experiment to implement and evaluate training interventions: Training of nurses and clinic managers to scale-up PITC of TB patients Training of lay counsellors to provide high quality HIV counselling services to TB patients Training of DOT supporters to continuously and more effectively encourage and motivate TB patients to take up HIV counselling and testing
  21. 21. Funders: Department for International Development (DfID, UK) National Research Foundation University of the Free State Authorisation: Free State Department of Health Collaboration: Department of Sociology, University of Antwerp American International Health Alliance SUNY Downtown Medical Center Ethical clearance: Committee for Research Ethics, Faculty of the Humanities, University of the Free State Colleagues: A Pienaar, H Hlophe, M Machere Drs P Chikobvu, E Wouters, H van den Berg
  22. 22. FSDoH. 2009. Tuberculosis statistical reports. http://www.fshealth.gov.za. NDoH. 2007. Tuberculosis Strategic Plan for South Africa, 2007- 2011. Pretoria: NDoH. WHO. 2004. Interim policy on collaborative TB/HIV activities. Geneva: WHO. WHO. 2009. Global tuberculosis control 2009: epidemiology, strategy, financing. Geneva: WHO.

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